Abstract WP305: Predictors of Early Improvement of Swallow Function in Acute Ischemic Stroke Patients With Severe Dysphagia

Abstract

Introduction: Dysphagia is a common complication of stroke that often improves with time. Percutaneous endoscopic gastrostomy (PEG) tubes are used to bridge patients with dysphagia until oral feeding is safe. We sought to evaluate factors associated with early improvement in swallow for patients in whom PEG tube was deferred after an initial failed instrumental assessment of swallow (IAS) study. Methods: Consecutive cases of AIS were identified from our inpatient registry (6/14- 4/15). We included patients who failed an initial IAS with Fiberoptic Endoscopic Evaluation of Swallowing or Modified Barium Swallow Study. Speech language pathologists (SLP) calculated Penetration-Aspiration (PEN-ASP) scores (1-2 normal; 3-5 penetration; 6-8 aspiration) based on performance on IAS. Recovery of swallow was defined as improvement in the PEN-ASP category with thin or nectar-thickened liquids. Univariate analyses and multiple logistic regression were used to assess predictors of improvement in swallow with demographic data, medical history, stroke etiology, and NIHSS as independent variables. Results: Among 104 patients who failed an IAS an average of 5.5 days after hospital admission, PEG was deferred in 60 pending repeat IAS. Younger patients (62.9±13.1 vs 69.3±14.2) and those with lower NIHSS (median 10.5; IQR 5,15 vs median 13.5; IQR 8.0, 20) were more often referred for second IAS (p < 0.05). Improvement in swallow function was seen in 45% of patients on a 2 nd IAS performed an average of 3.9 days after the initial study. Race, but not stroke etiology, stroke severity, stroke location or other clinical factors, was associated with recovery of swallow. The odds (adjusted) of improving on a subsequent evaluation in African Americans (AA) were 5.91 (95% CI: 1.56, 22.40 ) times higher than the odds for Whites. Conclusion: Our study shows that AA race is associated with early improvement in swallow function for reasons that are unclear. There was no association with age, stroke severity, or stroke etiology. Further analysis of factors associated with recovery of swallow is necessary in order to avoid PEG placement in patients with rapid recovery. A follow-up IAS 3-4 days after an initial study should be considered in select patients before PEG placement.